title: Individual risk factors and complexity associated with congenital heart disease in a pediatric medicaid cohort.
abstract: OBJECTIVE
  To determine the sex and race differences associated with specific congenital heart diseases (CHDs) and the patterns of concomitant conditions associated with eight severe, complex lesions.
  
  
  METHODS
  A 15-year Medicaid dataset (1996-2010) from one state was analyzed for 14,496 patients aged 17 years and younger and diagnosed as having a CHD on one or more service visits to a pediatrician or pediatric cardiologist.
  
  
  RESULTS
  Controlling for all other diagnosed CHDs, boys were more likely to be diagnosed as having transposition of the great arteries, hypoplastic left heart syndrome, aortic stenosis, and coarctation of the aorta, whereas African Americans were more likely to be diagnosed as having tricuspid regurgitation, atrial septal defect sinus venosus, coronary artery anomaly, and pulmonary stenosis. Ventricular septal defects, atrial septal defects secundum, patent ductus arteriosus, and pulmonary stenosis were the most prevalent isolated CHDs, whereas tetralogy of Fallot, atrioventricular canal/endocardial cushion defect, common/single ventricle, double outlet right ventricle, and transposition of the great arteries were the most prevalent severe, complex lesions. The complexity of some severe cardiac anomalies appears to be increasing over time.
  
  
  CONCLUSIONS
  Changes over time in pediatric CHD caseload mix may affect care management and result in prognosis or outcome differences. These changes present important opportunities for pediatricians and pediatric cardiologists to collaborate, especially in the care of the most severe anomalies.
authors.affiliation: University of South Carolina School of Medicine, Columbia, SC, USA.
authors.forename: C Osborne
authors.initials: CO
authors.lastname: Shuler
authors.forename: Avnish
authors.initials: A
authors.lastname: Tripathi
authors.forename: George B
authors.initials: GB
authors.lastname: Black
authors.forename: Yong-Moon Mark
authors.initials: YM
authors.lastname: Park
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Jerrell
mesh_terms: D044467:American Indian or Alaska Native / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008484:Medicaid; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*